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Articulo desarrollado por Nilton Custodio, Sheila Castro-Suarez, Eder Herrera-Pérez, David Lira, Rosa Montesinos, Erik Guevara-Silva, Liza Núñez del Prado y Nora Rojas para la revista Interciencia.
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Interciencia 2013;4(3):105 - 112 Síntomas neuropsiquiátricos en Parkinson 105
ARTÍCULO ORIGINAL
Alteraciones neuropsiquiátricas de pacientes con
deterioro cognitivo leve y demencia asociada a la
enfermedad de Parkinson
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RESUMEN
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Cómo citar el artículo: Custodio N, Castro-Suarez S, Herrera-Pérez E, Lira D, Montesinos R, Guevara-Silva E, Núñez L, Rojas N. Alteraciones neuro-psiquiátricas de pacientes con deterioro cognitivo leve y demencia asociada a la enfermedad de Parkinson. Interciencia. 2013;4(3): 105-112.
Interciencia 2013;4(3):105 - 112Custodio N. et al.106
ARTÍCULO ORIGINAL
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* EP-CN vs. DEP p < 0,01 †�(3�'&/�YV��'(3�S�Ӻ�����BDI-II: Beck Depression Inventory–version II, MMSE: Mini Mental State Examination, ACE: Addenbroke’s Cognitive Examination.
Los resultados entre paréntesis corresponden a la desviación estándar (DS).
EdadGénero (F:M)
Educación (en años)Duración EP (en años)
Hoehn-YahrBDI-IIACE
63,9 (6,3)7:15
10,9 (2,5)6,2 (3,4)1,8 (0,6)12,3 (2,7)91,9 (3,3)
70,6 (8,2)7:11
10,1 (2,4)6,4 (2,7)2,1 (0,4)11,5 (4,3)84,3 (4,1)
NSNSNSNS
< 0,01*NS
< 0,001*†
71,4 (7,1)8:15
10,3 (2,6)8,8 (5,9)2,6 (0,3)12,2 (6,7)74,9 (4,6)
PEP-CNn = 22
EP-DCLn = 18
DEPN = 23
Interciencia 2013;4(3):105 - 112 Síntomas neuropsiquiátricos en Parkinson 109
ARTÍCULO ORIGINAL
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Tabla 2. Puntuación promedio de los ítems del Neuropsychiatric Inventory (NPI) en todos los pacientes con enfermedad de Parkinson, según nivel de deterioro cognitivo y pacientes que muestran síntomas.
Ítem NPI
Delusiones
Alucinaciones
Agitación/agresividad
Depresión/disforia
Ansiedad
Euforia
Apatía
Desinhibición
Irritabilidad
Conducta motora aberrante
Problemas de sueño
Problemas de apetito
NPI TOTAL
EP-CN (n = 22)
TodosPuntos en NPI media (DS)0,43
(1,38)0,48
(1,53)0,58
(1,52)2,37
(2,65)2,23
(2,49)0,24
(1,11)1,41
(2,10)0,25
(0,93)1,12
(1,79)0,28
(1,27)1,34
(0,98)0,47
(0,36)9,64
(9,36)
Puntos en NPI media (DS)3,36
(2,79)2,90
(2,38)2,54 (227)3,46
(2,63)3,25
(2,56)2,25
(2,38)2,91
(2,49)2,12
(1,98)2,42
(1.12)2.78
(2,48)3,16
(2,45)2,56
(1,89)11,24
(10,43)
Porcentaje FRQ�13,����
N (% total)
2 (9,1)
2(9,1)
1 (4,5)
7(31,8)
6(27,3)
1(4,5)
4(18,2)
2(9,1)
4(18,2)
1(4,5)
2(9,1)
2(9,1)14
(63,6)
Pacientes con SNP TodosPuntos en NPI media (DS)1,25
(1,27)0.87
(1,45)0,67
(1,58)2,59
(2,08)2,81
(2,12)0,28
(1,23)1,98
(1,89)0,57
(1,12)1,25
(1,68)0,75
(1,43)1,45
(1,16)1,21
(0,76)12,13
(10,76)
Puntos en NPI media (DS)2,45
(2,13)2.06
(1,98)2,24
(2,18)2,17
(2,34)3,96
(2,71)2,23
(2,16)3,56
(2,54)2,28
(1,76)3,81
(2,37)2,16
(1,76)3,16
(1,76)2,68
(1,94)14,35
(11,56)
Porcentaje FRQ�13,����
N (% total)
4 (22,2)
3(16,6)
4(22,2)
3(16,6)
6(33,3)
3(16,6)
7(38,9)
3(16,6)
5(27,8)
3(16,6)
6(33,3)
4(22,2)
13(72,2)
Pacientes con SNP TodosPuntos en NPI media (DS)1,98
(3,56)1,99
(3,12)1.31
(2,23)1,56
(2,56)1,83
(2,71)0,18
(0,68)2,58
(3,59)0,46
(1,23)1,42
(2,47)1,32
(2,48)2,56
(3,67)1,97
(3,84)19,35
(20,43)
Puntos NPI
media (DS)4.96
(3,74)3,93
(3,42)2,98
(2,48)3,16
(2,88)3,17
(2,79)1,51(1,1)4,77
(3,49)2,46(2,1)3,53
(2,96)3,56(3,8)4,87
(3,71)4,14
(3,88)21,42
(20,54)
Porcentaje FRQ�13,����
N (% total)
6(26,1)
5(21,7)
3(13)
4(17,4)
5(21,7)
1(4,3)
8(34,8)
1(4,3)
3(13)
4(17,4)
8(34,8)
6(26,1)
17(73,9)
Pacientes con SNP
EP-DCL (n = 18) DEP (n = 23)
Interciencia 2013;4(3):105 - 112Custodio N. et al.110
ARTÍCULO ORIGINAL
Tabla 3. Proporción de pacientes con SNP en pacientes con DEP.
DelusionesAlucinaciones
Agitación/agresividadDepresión/disforia
AnsiedadEuforiaApatía
DesinhibiciónIrritabilidad
Conducta motora aberranteProblemas de sueñoProblemas de apetito
Síntomaneuropsiquiátrico
5810414311498128
N
21,734.743,517,460,913,047,817,439,134,752,234.7
%
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Interciencia 2013;4(3):105 - 112Custodio N. et al.112
REFERENCIAS
1. Chaudhuri KR, Yates L, Martinez-Martin P. The non-motor symptom FRPSOH[�RI�3DUNLQVRQ·V�GLVHDVH��D�FRPSUHKHQVLYH�DVVHVVPHQW�LV�essential. Curr Neurol Neurosci Rep. 2005;5:275-83.
2. Aarsland D, Bronnick K, Larsen JP, Tysnes OB, Alves G. Cognitive impairment in incident, untreated Parkinson disease: the Norwegian ParkWest study. Neurology. 2009;72:1121-6.
3. Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, et al. Range of neuropsychiatric disturbances in patients ZLWK� 3DUNLQVRQ·V� GLVHDVH�� -� 1HXURO� 1HXURVXUJ� 3V\FKLDWU\��1999;67:492-6.
��� (PUH�0��'HPHQWLD�DVVRFLDWHG�ZLWK�3DUNLQVRQ·V�GLVHDVH��/DQFHW�Neurol. 2003;2:229-37.
��� 3OXFN�*&��%URZQ�5*��$SDWK\�LQ�3DUNLQVRQ·V�GLVHDVH��-�1HXURO�Neurosurg Psychiatry. 2002;73:636-42.
6. Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang $(��HW�DO��$�ÀYH�\HDU�VWXG\�RI�WKH�LQFLGHQFH�RI�G\VNLQHVLD�LQ�SDWLHQWV�ZLWK�HDUO\�3DUNLQVRQ·V�GLVHDVH�ZKR�ZHUH�WUHDWHG�ZLWK�URSLQLUROH�RU�levodopa. 056 Study Group. N Engl J Med. 2000;342:1484-91.
��� %DUQHV�-��'DYLG�$6��9LVXDO�KDOOXFLQDWLRQV�LQ�3DUNLQVRQ·V�GLVHDVH��a review and phenomenological survey. J Neurol Neurosurg Psychiatry. 2001;70:727-33.
8. Aarsland D, Ballard C, Larsen JP, & McKeith I. A comparative study of psychiatric symptoms in dementia with Lewy bodies DQG�3DUNLQVRQ·V�GLVHDVH�ZLWK�DQG�ZLWKRXW�GHPHQWLD��,QW�-�*HULDWU�Psychiatry. 2001;16:528-36.
��� 1LOVVRQ� )0�� 3V\FKLDWULF� DQG� FRJQLWLYH� GLVRUGHUV� LQ� 3DUNLQVRQ·V�disease. Curr Opin Psychiatry. 2004;17:197-202.
10. Parkinson Study Group. Low-dose clozapine for the treatment of GUXJ�LQGXFHG� SV\FKRVLV� LQ� 3DUNLQVRQ·V� GLVHDVH�� 1� (QJO� -� 0HG��1999;340:757-63.
11. Parkinson Study Group. Pramipexole v. levodopa as initial treatment for Parkinson disease: a randomized controlled trial. JAMA. 2000;284:1931-38.
12. Hughes CP, Berg L, Danzinger WL, Coben LA, Martin RL. A new clinical scale for staging of dementia. Br J Psychiatry. 1982;140:566-72.
13. Gibb WR, Lees AJ. The relevance of the Lewy body to the SDWKRJHQHVLV� RI� LGLRSDWKLF� 3DUNLQVRQ·V� GLVHDVH�� -� 1HXURO�Neurosurg Psychiatry. 1988;51:745-52.
14. Hoehn MM and Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967; 17: 427-42.
15. Diagnostic and statistical manual of mental disorders, 4th ed.: DMS-IV. Washington, D.C.: American Psychiatric Association, 1994.
16. Folstein MF, Folstein SE, McHugh PR. «Mini-mental state»: a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res. 1975;12:189-98.
17. Custodio N, García A, Montesinos R, Lira D, Bendezú L. Validación de la prueba de dibujo de reloj-versión de Manos como prueba de cribado para detectar demencia en una población adulta mayor de Lima, Perú. Rev Peru Med Exp Salud Pública. 2011;28(1):29-34.
18. Quiroga P, Albala C, Klaasen G. Validación de un test de tamizaje para el diagnóstico de demencia asociado a edad, en Chile. Rev Med Chile. 2004;132:467-78.
19. Custodio N, Lira D, Montesinos R, Gleichgerrcht E, Manes F. 8WLOLGDG� GHO� $GGHQEURRNHV·V� &RJQLWLYH� ([DPLQDWLRQ� YHUVLyQ� HQ�español en pacientes peruanos con enfermedad de Alzheimer y demencia frontotemporal. Vertex Rev Arg de Psiquiat.
2012;XXIII:165-72. 20. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi
DA, Gornbein J. The Neuropsychiatric Inventory; Comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308-14.
21. Kulisevsky J, Pagonabarraga J, Pascual-Sedano B, García-Sanchez C, Gironell A. Prevalence and correlates of neuropsychiatric symptoms in Parkinson´s disease without dementia. Mov Disord. 2008;23(13):1889-96.
22. Lee AH, Weintraub D. Psychosis in Parkinson´s disease without dementia: Common and comorbid with other non-motor symptoms. Mov Disord. 2012;27(7):858-63.
23. Aarsland D, Bronnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, HW� DO�� 1HXURSV\FKLDWULF� V\PSWRPV� LQ� SDWLHQWV� ZLWK� 3DUNLQVRQ·V�GLVHDVH� DQG� GHPHQWLD�� IUHTXHQF\�� SURÀOH� DQG� DVVRFLDWHG� FDUH�giver stress. J Neurol Neurosurg Psychiatry. 2007;78:36-42.
24. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: ÀQGLQJV�IURP�WKH�&DFKH�&RXQW\�6WXG\�RQ�0HPRU\�LQ�$JLQJ��$P�-�Psychiatry. 2000;157:708-14.
25. Lee WJ, Tsai C, Gauthier S, Wang S, Fuh JL. The association between cognitive impairment and neuropsychiatric symptoms in patients with Parkinson´s disease dementia. Int Psychogeriatr. 2012;24:1980-97.
26. Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, et al. Clinical diagnostic criteria for dementia associated with Parkinson´s disease. Mov Disord. 2007;22:1689-707.
27. Aarsland D, Cummings JL and Larsen JP. Neuropsychiatric GLIIHUHQFHV� EHWZHHQ� 3DUNLQVRQ·V� GLVHDVH� ZLWK� GHPHQWLD� DQG�$O]KHLPHU·V�GLVHDVH��,QW�-�*HULDWU�3V\FKLDWU\�������������-91.
28. Fuh JL, Liu CK, Mega MS, Wang SJ and Cummings JL. Behavioral GLVRUGHUV� DQG� FDUHJLYHUV·� UHDFWLRQ� LQ� 7DLZDQHVH� SDWLHQWV� ZLWK�$O]KHLPHU·V�GLVHDVH��,QW�3V\FKRJHULDWU�������������-28.
���� )DFWRU�6$��0ROKR�(6��3RGVNDOQ\�*'�DQG�%URZQ�'��3DUNLQVRQ·V�disease: drug-induced psychiatric states. Advances in Neurology. 1995;65:115-38.
30. Fenelon G, Goetz CG and Karenberg A. Hallucinations in Parkinson disease in the pre-levodopa era. Neurology. 2006;66:93-8.
31. Williams DR and Lees AJ. Visual hallucinations in the diagnosis RI� LGLRSDWKLF�3DUNLQVRQ·V�GLVHDVH��D� UHWURVSHFWLYH�DXWRSV\�VWXG\��Lancet Neurol. 2005;4:605-10.
Correspondencia:
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Interciencia 2013;4(3):113-120 Neuropsychiatric Symptoms in Parkinson’s Disease 113
ORIGINAL ARTICLE
Neuropsychiatric disorders in patients with mild
cognitive impairment and dementia associated
with Parkinson’s disease
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ABSTRACT
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Interciencia 2013;4(3):113-120Custodio N. et al.116
ORIGINAL ARTICLE
PU�[OL�JVNUP[P]L�M\UJ[PVU�K\YPUN�[OL�SHZ[�`LHY·^OL[OLY�I`� [OL� WH[PLU[� VY� H� JHYLNP]LY�� HUK� JVUÄYTLK� I`� [OL�UL\YVWZ`JOVSVNPJHS�HZZLZZTLU[�¶^P[OV\[�KLTLU[PH�HUK�JOHUNLZ�PU�HJ[P]P[PLZ�VM�KHPS`�SPML�
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Table 1��'HPRJUDSKLF�FKDUDFWHULVWLFV�RI�SDWLHQWV�ZLWK�3DUNLQVRQ·V�GLVHDVH�DFFRUGLQJ�WR�WKH�FRJQLWLYH�LPSDLUPHQW�OHYHO��3'�&1��3'�0&,�DQG�3''��
* PD-CN vs. PDD p < 0.01 †PD-MCI vs. PDD p < 0.01 BDI-II: Beck Depression Inventory–version II. MMSE: Mini Mental State Examination. ACE: Addenbroke’s Cognitive Examination.
Results in parentheses correspond to standard deviation (SD).
AgeGender (F:M)
Education (in years)PD Duration (in years)
Hoehn-YahrBDI-IIACE
63.9 (6.3)7:15
10.9 (2.5)6.2 (3.4)1.8 (0,6)12.3 (2.7)91.9 (3.3)
70.6 (8.2)7:11
10.1 (2.4)6.4 (2.7)2.1 (0.4)11.5 (4.3)84.3 (4.1)
NSNSNSNS
< 0.01*NS
< 0.001*†
71.4 (7.1)8:15
10.3 (2.6)8.8 (5.9)2.6 (0.3)12.2 (6.7)74.9 (4.6)
PPD-CNn = 22
PD-MCIn = 18
PDDN = 23
Interciencia 2013;4(3):113-120 Neuropsychiatric Symptoms in Parkinson’s Disease 117
ORIGINAL ARTICLE
;HISL���ZOV^Z�[OL�H]LYHNL�ZJVYL�MVY�LHJO�PUKP]PK\HS�P[LT�VM�HSS� [OL�7+�*5�WH[PLU[Z��VM� [OVZL�WH[PLU[Z�^OV�ZOV^LK� H[� SLHZ[� ZVTL�57:� �U� $� ��"� ������� HUK� [OL�WLYJLU[HNL�VM�[OVZL�̂ OV�VI[HPULK�H�ZJVYL�OPNOLY�[OHU�VY�LX\HS�[V���PU�LHJO�P[LT�VM�[OL�570����������;OL�H]LYHNL�ZJVYL�HUK�Z[HUKHYK�KL]PH[PVU��:+��VM�[OL�570�VM�HSS�WH[PLU[Z�PU�[OL�7+�*5�NYV\W�^HZ� ������ �����YLZWLJ[P]LS �̀��;OL�TVZ[� JVTTVU� Z`TW[VTZ� ^LYL� KLWYLZZPVU� �U� $� ��"��������HUK�HU_PL[`��U�$���"���������MVSSV^LK�I`�HWH[O`��U�$���"��������HUK�PYYP[HIPSP[`��U�$� "���� �����������VM�[OVZL�̂ OV�OHK�H[�SLHZ[�VUL�57:��YLWYLZLU[PUN�������V\[�VM�[OL�[V[HS�NYV\W��OHK�H[�SLHZ[�VUL�Z`TW[VT�̂ P[O�H�ZJVYL�OPNOLY� [OHU�VY�LX\HS� [V���� �(TVUN� [OLZL�WH[PLU[Z�� [OL�OPNOLZ[�ZJVYL�JVYYLZWVUKLK�[V�KLWYLZZPVU���������������HUK�KLS\ZPVUZ������������ ���MVSSV^LK�I`�HU_PL[`���������������HUK�HWH[O`���� ������� ��
0U� 7+�4*0� [OL� WLYJLU[HNL�VM� WH[PLU[Z�^OV�OHK� H[�SLHZ[�VUL�57:�^HZ����������� PUKP]PK\HSZ���^OPSL� [OH[�VM�WH[PLU[Z�YLHJOPUN�H�ZJVYL�OPNOLY�[OHU�VY�LX\HS�[V���MVY�H[�SLHZ[�VUL�P[LT�VM�[OL�570�^HZ��������;OL�H]LYHNL�ZJVYL�HUK�Z[HUKHYK�KL]PH[PVU�VM�[OL�570�MVY�HSS�[OL�7+�4*0�WH[PLU[Z�^HZ����������������YLZWLJ[P]LS �̀�;OL�TVZ[�JVTTVU� Z`TW[VTZ� ^LYL� HU_PL[`� �U� $� ��"� ��������KLWYLZZPVU��U�$���"��������HUK�HWH[O`��U�$���"���������(TVUN� WH[PLU[Z� ^OV� OHK� H[� SLHZ[� VUL� 57:� HUK� VUL�Z`TW[VT�ZJVYLK�OPNOLY�[OHU�VY�LX\HS�[V����[OL�OPNOLZ[�ZJVYLZ�^LYL� VI[HPULK� PU� [OL� P[LTZ�VM� HU_PL[`� ��� �����������HWH[O`����������������PYYP[HIPSP[`���������������HUK�ZSLLW�KPZVYKLYZ���������������
4VZ[� WH[PLU[Z� VM� [OL� 7++� NYV\W� �U� $� ��"� ������OHK�H[�SLHZ[�VUL�57:��^OPSL�[OL�WLYJLU[HNL�VM�WH[PLU[Z�
Table 2��$YHUDJH�VFRUH�RI� WKH� LWHPV� LQ� WKH�1HXURSV\FKLDWULF� ,QYHQWRU\� �13,�� LQ�DOO� SDWLHQWV�ZLWK�3DUNLQVRQ·V�GLVHDVH��DFFRUGLQJ� WR� FRJQLWLYH�impairment level and patients showing symptoms.
Item NPI
Delusions
Hallucinations
Agitation / aggressiveness
Depression / dysphoria
Anxiety
Euphoria
Apathy
Disinhibition
Irritability
Aberrant motor behavior
Sleep disorders
Appetite problems
NPI TOTAL
PD-CN (n = 22)
AllPoints in
NPI mean (SD)0.43
(1.38)0.48
(1.53)0.58
(1.52)2.37
(2.65)2.23
(2.49)0.24
(1.11)1.41
(2.10)0.25
(0.93)1.12
(1.79)0.28
(1.27)1.34
(0.98)0.47
(0.36)9.64
(9.36)
Pointsin NPImean(SD)3.36
(2.79)2.90
(2.38)2.54 (227)3.46
(2.63)3.25
(2.56)2.25
(2.38)2.91
(2.49)2.12
(1.98)2,42
(1.12)2.78
(2.48)3.16
(2.45)2.56
(1.89)11.24
(10.43)
PercentageZLWK�13,���
N (% total)
2 (9.1)
2(9.1)
1 (4.5)
7(31.8)
6(27.3)
1(4.5)
4(18.2)
2(9.1)
4(18.2)
1(4.5)
2(9.1)
2(9.1)14
(63.6)
Patients con NPS AllPoints in
NPI mean (SD)1.25
(1.27)0.87
(1.45)0.67
(1.58)2.59
(2.08)2.81
(2.12)0.28
(1.23)1.98
(1.89)0.57
(1.12)1.25
(1.68)0.75
(1.43)1.45
(1.16)1.21
(0.76)12.13
(10.76)
Pointsin NPImean(SD)2.45
(2.13)2.06
(1.98)2.24
(2.18)2.17
(2.34)3.96
(2.71)2.23
(2.16)3.56
(2.54)2.28
(1.76)3.81
(2.37)2.16
(1.76)3.16
(1.76)2.68
(1.94)14.35
(11.56)
PercentageZLWK�13,���
N (% total)
4 (22.2)
3(16.6)
4(22.2)
3(16.6)
6(33.3)
3(16.6)
7(38.9)
3(16.6)
5(27.8)
3(16.6)
6(33.3)
4(22.2)
13(72.2)
Patients con NPS AllPoints in
NPI mean (SD)1.98
(3.56)1,99
(3.12)1.31
(2.23)1.56
(2.56)1.83
(2.71)0.18
(0.68)2.58
(3.59)0.46
(1.23)1.42
(2.47)1.32
(2.48)2.56
(3.67)1.97
(3.84)19.35
(20.43)
Pointsin NPImean(SD)4.96
(3.74)3.93
(3.42)2.98
(2.48)3.16
(2.88)3.17
(2.79)1.51(1.1)4.77
(3.49)2.46(2.1)3.53
(2.96)3.56(3.8)4.87
(3.71)4.14
(3.88)21.42
(20.54)
PercentageZLWK�13,���
N (% total)
6(26.1)
5(21.7)
3(13)
4(17.4)
5(21.7)
1(4.3)
8(34.8)
1(4.3)
3(13)
4(17.4)
8(34.8)
6(26.1)
17(73.9)
Pacientes con SNP
PD-MCI (n = 18) PDD (n = 23)
Interciencia 2013;4(3):113-120Custodio N. et al.118
ORIGINAL ARTICLE
Table 3. Percentage of patients with NPS out of PDD patients.
DelusionsHallucinations
Agitation / aggressivenessDepression / dysphoria
AnxietyEuphoriaApathy
DisinhibitionIrritability
Aberrant motor behaviorSleep disorders
Appetite problems
Neuropsychiatric Symptoms
5810414311498128
N
21.734.743.517.460.913.047.817.439.134.752.234.7
%
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ORIGINAL ARTICLE
Interciencia 2013;4(3):113-120Custodio N. et al.120
REFERENCES
1. Chaudhuri KR, Yates L, Martinez-Martin P. The non-motor V\PSWRP� FRPSOH[� RI� 3DUNLQVRQ·V� GLVHDVH�� D� FRPSUHKHQVLYH�assessment is essential. Curr Neurol Neurosci Rep. 2005;5:275-83.
2. Aarsland D, Bronnick K, Larsen JP, Tysnes OB, Alves G. Cognitive impairment in incident, untreated Parkinson disease: the Norwegian ParkWest study. Neurology. 2009;72:1121-6.
3. Aarsland D, Larsen JP, Lim NG, Janvin C, Karlsen K, Tandberg E, et al. Range of neuropsychiatric disturbances in patients ZLWK� 3DUNLQVRQ·V� GLVHDVH�� -� 1HXURO� 1HXURVXUJ� 3V\FKLDWU\��1999;67:492-6.
��� (PUH�0��'HPHQWLD�DVVRFLDWHG�ZLWK�3DUNLQVRQ·V�GLVHDVH��/DQFHW�Neurol. 2003;2:229-37.
��� 3OXFN�*&��%URZQ�5*��$SDWK\�LQ�3DUNLQVRQ·V�GLVHDVH��-�1HXURO�Neurosurg Psychiatry. 2002;73:636-42.
6. Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, /DQJ�$(��HW�DO��$�ÀYH�\HDU�VWXG\�RI� WKH� LQFLGHQFH�RI�G\VNLQHVLD�LQ� SDWLHQWV� ZLWK� HDUO\� 3DUNLQVRQ·V� GLVHDVH� ZKR� ZHUH� WUHDWHG�with ropinirole or levodopa. 056 Study Group. N Engl J Med. 2000;342:1484-91.
��� %DUQHV�-��'DYLG�$6��9LVXDO�KDOOXFLQDWLRQV�LQ�3DUNLQVRQ·V�GLVHDVH��a review and phenomenological survey. J Neurol Neurosurg Psychiatry. 2001;70:727-33.
8. Aarsland D, Ballard C, Larsen JP, & McKeith I. A comparative study of psychiatric symptoms in dementia with Lewy bodies DQG�3DUNLQVRQ·V�GLVHDVH�ZLWK�DQG�ZLWKRXW�GHPHQWLD��,QW�-�*HULDWU�Psychiatry. 2001;16:528-36.
��� 1LOVVRQ� )0�� 3V\FKLDWULF� DQG� FRJQLWLYH� GLVRUGHUV� LQ� 3DUNLQVRQ·V�disease. Curr Opin Psychiatry. 2004;17:197-202.
10. Parkinson Study Group. Low-dose clozapine for the treatment of GUXJ�LQGXFHG�SV\FKRVLV� LQ�3DUNLQVRQ·V�GLVHDVH��1�(QJO� -�0HG��1999;340:757-63.
11. Parkinson Study Group. Pramipexole v. levodopa as initial treatment for Parkinson disease: a randomized controlled trial. JAMA. 2000;284:1931-38.
12. Hughes CP, Berg L, Danzinger WL, Coben LA, Martin RL. A new clinical scale for staging of dementia. Br J Psychiatry. 1982;140:566-72.
13. Gibb WR, Lees AJ. The relevance of the Lewy body to the SDWKRJHQHVLV� RI� LGLRSDWKLF� 3DUNLQVRQ·V� GLVHDVH�� -� 1HXURO�Neurosurg Psychiatry. 1988;51:745-52.
14. Hoehn MM and Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967; 17: 427-42.
15. Diagnostic and statistical manual of mental disorders, 4th ed.: DMS-IV. Washington, D.C.: American Psychiatric Association, 1994.
16. Folstein MF, Folstein SE, McHugh PR. «Mini-mental state»: a practical method for grading the cognitive state of patients for the clinician. J Psychiat Res. 1975;12:189-98.
17. Custodio N, García A, Montesinos R, Lira D, Bendezú L. Validación de la prueba de dibujo de reloj-versión de Manos como prueba de cribado para detectar demencia en una población adulta mayor de Lima, Perú. Rev Peru Med Exp Salud Pública. 2011;28(1):29-34.
18. Quiroga P, Albala C, Klaasen G. Validación de un test de tamizaje para el diagnóstico de demencia asociado a edad, en Chile. Rev Med Chile. 2004;132:467-78.
19. Custodio N, Lira D, Montesinos R, Gleichgerrcht E, Manes F. 8WLOLGDG� GHO�$GGHQEURRNHV·V� &RJQLWLYH� ([DPLQDWLRQ� YHUVLyQ� HQ�español en pacientes peruanos con enfermedad de Alzheimer y demencia frontotemporal. Vertex Rev Arg de Psiquiat. 2012;XXIII:165-72.
20. Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory; Comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308-14.
21. Kulisevsky J, Pagonabarraga J, Pascual-Sedano B, García-Sanchez C, Gironell A. Prevalence and correlates of neuropsychiatric symptoms in Parkinson´s disease without dementia. Mov Disord. 2008;23(13):1889-96.
22. Lee AH, Weintraub D. Psychosis in Parkinson´s disease without dementia: Common and comorbid with other non-motor symptoms. Mov Disord. 2012;27(7):858-63.
23. Aarsland D, Bronnick K, Ehrt U, De Deyn PP, Tekin S, Emre M, HW� DO�� 1HXURSV\FKLDWULF� V\PSWRPV� LQ� SDWLHQWV� ZLWK� 3DUNLQVRQ·V�GLVHDVH� DQG� GHPHQWLD�� IUHTXHQF\�� SURÀOH� DQG� DVVRFLDWHG� FDUH�giver stress. J Neurol Neurosurg Psychiatry. 2007;78:36-42.
24. Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JC. Mental and behavioral disturbances in dementia: ÀQGLQJV�IURP�WKH�&DFKH�&RXQW\�6WXG\�RQ�0HPRU\�LQ�$JLQJ��$P�-�Psychiatry. 2000;157:708-14.
25. Lee WJ, Tsai C, Gauthier S, Wang S, Fuh JL. The association between cognitive impairment and neuropsychiatric symptoms in patients with Parkinson´s disease dementia. Int Psychogeriatr. 2012;24:1980-97.
26. Emre M, Aarsland D, Brown R, Burn DJ, Duyckaerts C, Mizuno Y, et al. Clinical diagnostic criteria for dementia associated with Parkinson´s disease. Mov Disord. 2007;22:1689-707.
27. Aarsland D, Cummings JL and Larsen JP. Neuropsychiatric GLIIHUHQFHV� EHWZHHQ� 3DUNLQVRQ·V� GLVHDVH� ZLWK� GHPHQWLD� DQG�$O]KHLPHU·V�GLVHDVH��,QW�-�*HULDWU�3V\FKLDWU\�������������-91.
28. Fuh JL, Liu CK, Mega MS, Wang SJ and Cummings JL. Behavioral GLVRUGHUV� DQG� FDUHJLYHUV·� UHDFWLRQ� LQ� 7DLZDQHVH� SDWLHQWV� ZLWK�$O]KHLPHU·V�GLVHDVH��,QW�3V\FKRJHULDWU�������������-28.
���� )DFWRU�6$��0ROKR�(6��3RGVNDOQ\�*'�DQG�%URZQ�'��3DUNLQVRQ·V�disease: drug-induced psychiatric states. Advances in Neurology. 1995;65:115-38.
30. Fenelon G, Goetz CG and Karenberg A. Hallucinations in Parkinson disease in the pre-levodopa era. Neurology. 2006;66:93-8.
31. Williams DR and Lees AJ. Visual hallucinations in the diagnosis RI�LGLRSDWKLF�3DUNLQVRQ·V�GLVHDVH��D�UHWURVSHFWLYH�DXWRSV\�VWXG\��Lancet Neurol. 2005;4:605-10.
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